12th Congress of the European Hematology ... - Haematologica

all infection rate (p=0.12) as well as grade III/IV infection frequency
(p=0.23) among patients treated with DA-7 or DAC-7 regimen. Microbiologically
or clinically documented bacterial infections occurred in 127
(41%) patients, including 67 (43%) DA-7 patients and 60 (39%) DAC-7
patients (p=0.5). A total of 71 (23%) episodes of bacteremia were found,
including 60% Gram-positive, 30% Gram-negative, and 10% mixed
blood cultures. Forty-two (27%) patients in the DA-7 group and 29
(19%) patients in the DAC-7 group had bacteremia (p=0.06). Microbiologically
documented fungal infections occurred in 42 (13%) patients,
including 16 (10%) DA-7 patients and 26 (17%) DAC-7 patients (p=0.06).
A total of 5 (2%) episodes of fungemia were reported and its frequency
was similar in both study arms. Viral infections were observed in 35
(11%) patients and it did not occur more often in patients receiving
DAC-7 therapy when compared to patients treated with DA-7 regimen
(p=0.6). At univariate analysis, AML subtypes according to FAB classification,
preceding myelodysplastic syndrome, age, sex, induction treatment
arm, response to induction therapy, the presence of Hickman’s
catheter, and the use of antimicrobial prophylaxis were not significantly
associated with the risk of infection. In all, 11 (7%) patients died of
infection'related complications in the DA-7 arm compared to 17 (11%)
in the DAC-7 arm (p=0.4) Conclusions. Addition of cladribine to daunorubicin
and cytarabine did not result in significantly more infectious complications
than standard treatment with daunorubicin and cytarabine in
adult AML patients.
0619
ACICLOVIR PROPHYLAXIS FOLLOWING ALLOGENEIC STEM CELL TRANSPLANTATION
S. Bacchu, 1 K. Holder, 2 H. Osman, 2 J. Ewing2 1 University Hospitals of Wales, CARDIFF; 2 Birmingham Heartlands Hospital,
BIRMINGHAM, United Kingdom
Background. Herpes viruses establish a latent phase following primary
infection. Viral reactivation occurs in more than 30% patients following
allogeneic stem cell transplant. Most of cases occur between 3-12 months
after transplantation. Current evidence suggests that infection rates can
be decreased by giving prophylaxis however there is no consensus on
the duration of prophylaxis and doses. Our previous audit study (2001
-2003) showed that the administration of prophylaxis until neutrophil
engraftment left patients at risk of viral reactivation occurring in 76% of
allograft recipients leading to considerable morbidity and healthcare
cost. It was shown that these reactivations occurred during the period
of time prior to the recovery if CD4 count to a level of >300/mm 3 . The
audit outcome led to a decision to extend the duration of prophylaxis
until CD4>300/mm 3 , by doing so we hoped to considerably decrease
infection rates. Aim. The first aim of the study was to assess compliance
in prescribing to our own standard.We also needed to re-audit to assess
whether the change in standard resulted in reduction in herpes virus
reactivation rates as predicted from our previous study. Methods. This
was a single centre, retrospective study conducted at Birmingham Heartlands
Hospital with a study period between January2004 -January 2006.
All patients who survived >100days post-transplant were included. The
standard against which we assessed our practice was our own JACIE
standard operating protocol for prevention of infection post transplantation
(Joint accreditation committee of institute of cellular biology and
EBMT). The protocol stated to continue aciclovir prophylaxis at a dose
of 200mg bd until CD4 count reaches 300/mm 3 .Source data was
obtained from the transplant database, case notes, drug charts and confirmatory
virology reports.
Figure 1. Shows CD4 and HSV/VZV infection.
12 th Congress of the European Hematology Association
Results. In the current study there were twenty eight patients who
underwent allogenic transplant during the study period, five were
excluded due to transplant related mortality (n=23). Sixteen were Sibling
transplant and seven MUD.The median duration for of follow up was
442 days and median duration of prophylaxis was 348 days. During this
period there were 6/23 (26%) episodes of HSV/VZV infections (Figure
1). Compliance was seen in 21/23 patients (91%). Non-compliance with
prescribing resulted in one episodes each of HSV and VZV infection prior
to the target CD4 count being achieved. Four episodes of viral reactivation
occurred in patients with CD4>300/mm 3 . Of these two patients
had disseminated VZV infections resulting in hospitalisation and intravenous
aciclovir therapy. Three individuals have since suffered from
recurrent episodes of HSV/VZV and are on long term prophylaxis in
spite of attaining a CD4>300/mm 3 . Summary and Conclusions. In our previous
study there were sixteen episodes of HSV /VZV reactivation
(n=21). In comparison we had only six in our present study. There was
also a reduction in recurrent episodes from six (n=21) to four (n=23). We
have achieved a significant reduction in morbidity due to re-activation
of VZV and HSV infections in allogeneic bone marrow transplant
patients by our approach.
0620
HAEMATOLOGICAL FEATURES OF LEISHMANIASIS RESEMBLING BLOOD-RELATED
MALIGNANCIES: THE CONCERN OF A DIFFERENTIAL DIAGNOSIS THROUGH THE
PRESENTATION OF SIX CASES
M. Palombi, 1 P. Niscola, 1 M.M. Trawinska, 1 S. Fratoni, 2 A.P. Perrotti, 1
S. Amadori, 1 P. de Fabritiis1 1 2 Tor Vergata University, Sant'Eugenio, ROME; Pathology Department, S.Eugenio
Hospital, ROME, Italy
Background. Leishmaniasis is a chronic infectious disease from the
group of anthropozoonoses. It is caused by protozoa in the genus leishmania
flagellate. Infection is transmitted by insects; Mediterranean countries
are one of the major foci of this disease in the world. The course of
the disease may be acute, subacute and chronic and several forms are differentiated
such as visceral, cutaneous and mucocutaneous. The diagnosis
is established by serologic tests; however, parasitological findings in
macrophages of the bone marrow (BM) can be observed. Several signs
of disease, such as elevated temperature, gastrointestinal disorders,
splenomegaly and hepatomegaly, generalized lymphadenomegaly and
pancytopenia, may resemble several haematologic malignancies, for
which some challenging concerns may arise in the differential diagnosis,
as recently observed by us in a series of six cases that is hereby
reported. Case series. There were 6 patients (3 male) with a median age
of 34 (20-60) years. In all patients the symptomatolgy started gradually
with uncharacteristic manifestations, such as fatigue, gastrointestinal
discomforts, loss of appetite, nausea, and vomiting, accompanied by
fever. Temperature increased twice a day and was followed by shuddering
and very often by nocturnal sweating. Antibiotics and antipyretics
were used without any benefits. Subjective discomforts were increasingly
pronounced, so that due to unclear febrile state and in addition to the
present pancytopenia for which patients kept under our attention. On
the physic examination all presented splenomegaly and three presented
lymphadenopathies. The laboratory findings pointed to pancytopenia
with lymphocytosis and monocytosis; moreover, important polyclonal
hypergammaglobulinemia ranging from 2 to 6 gr (median 4 gr.) was
found. BM aspirates and trephine biopsies were performed in all patients.
Hypocellularity was found in all cases; moreover, in three patients the
examination of BM smears revealed 15% to 25% polyclonal lymphocytes
infiltrating the BM. Lastly, both intra- and extracellular protozoa
resembling leishmaniasis were detectable in three cases. In the remaining
cases, no intramacrophagic or extracellular protozoa were found for
which the diagnosis was suspected and then confirmed by serologic
tests after the evaluation of all other diagnostic tests in order to exclude
an hematologic malignancy that were into normal values. After the
establishment of diagnosis, patients received causal therapy with liposomal
amphotericin B and rapidly recovered; the decrease of
splenomegaly as well the reduction of hypergammaglobulinemia and the
improvement in haematological findings were observed. Conclusions.
Hematologic findings which are characteristic for leishmaniasis may
resemble some of those associated with haematologic malignancy, such
as lymphomas and acute leukemias; however, in the presence of polyclonal
hypergammaglobulinemia, fever, splenomegaly and pancytopenia,
this infectious disease should be suspected and specific serologic
tests should be done together a BM examination.
haematologica/the hematology journal | 2007; 92(s1) | 231